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The Forearm,Wrist, and Hand
Sports Medicine 2Sports Medicine 2
Anatomy
Bones-Bones- MetacarpalsMetacarpals Radius and UlnaRadius and Ulna
Muscles-Muscles- Flexor carpi radialis – flexes and abductsFlexor carpi radialis – flexes and abducts Flexor carpi ulnaris – flexes and adductsFlexor carpi ulnaris – flexes and adducts Extensor carpi radialis (brevis and longus) – extends Extensor carpi radialis (brevis and longus) – extends
and abductsand abducts Extensor carpi ulnaris – extends and adductsExtensor carpi ulnaris – extends and adducts Palmaris longus – flexesPalmaris longus – flexes
Forearm Fractures
MOI: MOI: Blow or fall on the outstretched armBlow or fall on the outstretched arm
S&S: audible pop or crack, pain, swelling, S&S: audible pop or crack, pain, swelling, and disabilityand disability
TX: RICE, Splinting and castingTX: RICE, Splinting and casting
Colles’ Fracture
MOI: Fall on outstretched handMOI: Fall on outstretched hand S&S: Forward displacement of the radius, S&S: Forward displacement of the radius,
others are same as forearm fractureothers are same as forearm fracture TX: RICE, and castingTX: RICE, and casting
Wrist Tenosynovitis
MOI:MOI: Repetitive wrist acceleration and Repetitive wrist acceleration and
decelerationdeceleration Inflammation of the sheath around the Inflammation of the sheath around the
extensor carpi radialis longus and brevisextensor carpi radialis longus and brevis S&S: pain (active and passive stretching), S&S: pain (active and passive stretching),
tenderness over tendonstenderness over tendons TX: Ice massage, NSAIDS, and restTX: Ice massage, NSAIDS, and rest
Tendonitis
MOI:MOI: Overuse of the wristOveruse of the wrist
S&S: Pain on active or passive stretch and S&S: Pain on active or passive stretch and weaknessweakness
TX: RICE, NSAIDSTX: RICE, NSAIDS
Carpal Tunnel Syndrome
Carpal tunnel is located on the anterior Carpal tunnel is located on the anterior aspect of the wristaspect of the wrist
MOI: Repetitive wrist flexionMOI: Repetitive wrist flexion S&S: Sensory and motor deficitsS&S: Sensory and motor deficits TX: PRICE, sometime surgeryTX: PRICE, sometime surgery
De Quervain’s Disease
Stenosing tenosynovitis in the thumbStenosing tenosynovitis in the thumb MOI:MOI:
OveruseOveruse S&S: S&S:
Aching painAching pain TX: TX:
Immobilization, RICE, NSAIDSImmobilization, RICE, NSAIDS
Dislocation of Lunate Bone
MOI: MOI: Forceful hyperextension of the wristForceful hyperextension of the wrist
S&S:S&S: Pain, swelling, and difficulty executing wrist Pain, swelling, and difficulty executing wrist
and finger flexionand finger flexion TX:TX:
Ice and send to DR. for reductionIce and send to DR. for reduction If not properly treated necrosis of the bone is If not properly treated necrosis of the bone is
likelylikely
Hamate Fracture
MOI:MOI: Fall on outstretched arm, racket sportsFall on outstretched arm, racket sports
S&S:S&S: Wrist pain and weakness, and point Wrist pain and weakness, and point
tendernesstenderness TX:TX:
Cast and padding or removal of hookCast and padding or removal of hook
Scaphoid Fracture
MOI:MOI: Hyperextension of wristHyperextension of wrist
S&S:S&S: Pain and point tenderness in “snuff box”Pain and point tenderness in “snuff box”
TX:TX: Surgery to fixateSurgery to fixate
Wrist Ganglion
MOI:MOI: Synovial cystSynovial cyst Usually occurs on the back of wrist after wrist Usually occurs on the back of wrist after wrist
strainstrain S&S:S&S:
Occasional pain and a lumpOccasional pain and a lump TX:TX:
Surgical removal, aspiration, or bursting with Surgical removal, aspiration, or bursting with pressure pad afterwardspressure pad afterwards
Mallet Finger
MOI:MOI: Blow that strikes the tip of the finger causing a Blow that strikes the tip of the finger causing a
jamming or avulsion of the extensor tendonjamming or avulsion of the extensor tendon S&S:S&S:
Pain on the interphalangeal joint, deformityPain on the interphalangeal joint, deformity TX:TX:
RICE and splintingRICE and splinting
Boutonniere Deformity
Extension of DIP AND Flexion of PIPExtension of DIP AND Flexion of PIP MOI:MOI:
Rupture of the extensor tendon dorsal to the Rupture of the extensor tendon dorsal to the middle phalanxmiddle phalanx
S&S:S&S: Severe pain and inability to extend DIP jointSevere pain and inability to extend DIP joint
TX:TX: RICE, and splintingRICE, and splinting
Jersey Finger
MOI:MOI: grabbing a jersey or opponent and grabbing a jersey or opponent and
tendon rupturestendon ruptures S&S:S&S:
DIP joint cannot be flexedDIP joint cannot be flexed TX:TX:
Surgically repairedSurgically repaired
Gamekeepers Thumb
MOI:MOI: UCL Sprain of the thumbUCL Sprain of the thumb Forced hyperextensionForced hyperextension
S&S:S&S: Pain, weaknessPain, weakness
TX:TX: RICE, SplintRICE, Splint
Swan Neck Deformity
MOI:MOI: Severe hyperextensionSevere hyperextension
S&S:S&S: Pain and swelling in PIP jointPain and swelling in PIP joint
TX:TX: RICE, splinting in 20-30 degrees flexionRICE, splinting in 20-30 degrees flexion
Bennett’s Fracture
MOI:MOI: Fracture at the carpometacarpal jointFracture at the carpometacarpal joint Axial load and abductionAxial load and abduction
S&S:S&S: Pain and swelling over base of thumbPain and swelling over base of thumb
TX:TX: SurgerySurgery
Boxer’s Fracture
MOI:MOI: Fracture to the 5Fracture to the 5thth metacarpal metacarpal
S&S:S&S: Pain, point tenderness, swellingPain, point tenderness, swelling
TX:TX: Surgery to pinSurgery to pin